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HomeMy WebLinkAboutRP22-022PERMIT # /` P% - �cDATE: a a� EXP. 6j4j� 3 SECTION BLOCK LOT 3 TYPE OF WORK -0074C 4e JOB LOCATION r/ Vl, OWNERS u4 / U/I QC Ae/% /►7 r, 9/y} 5a3 53 7 CONTRACTOR Ae,17W PrOrl4e kLC - 1�tr�o• 7e C9 /y)579 - /EST. COST�t_J FEE A 5 �/ CO # Cv FEEj&IID! Pb DATE 3 TCO # FEE DATE INSPECTION RECORD DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING C] RGH PLUMBING GAS 0 SPRINKLER ELECTRIC 0 LOW -VOLT C� ALARM 0 AS BUILT 0 FINAL O?HER APPROVALS ARB BOT PB ZBA OTHER______. 41 a Ltc v . 19 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.ry ebrook.org TRUSTEES ACTING BUILDING & FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE February 7,2023 Joshua Broitman&Rachelle Simon 192 Country Ridge Drive Rye Brook,New York 10573 Re: 192 Country Ridge Drive,Rye Brook,New York 10573 Parcel ID#: 129.82-1-33 Roof Permit#22-022 issued on 6/2/2022 to Re-Roof Existing Building This certifies that the new roof,installed under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Acting Building&Fire Inspector /to D C E �`" C BUILDIN llEYA TMENT For office use only: DDPERMIT# a'-�c3 JUL 2 9 2022 VILLAGE OF RYE BROOK ISSUED: 38 KING STREET,RYE BROOK,NEw YORK 10573 DATE: 7—a9—c�a VILLAGE OF RYE BROOK (914)9 - -0668 FEE: .j /f 0— PAIDLW BUILDING DEPARTMENT www r 1 r APPLICATION FOR CERTIFICATE OF OCCUPANCY, CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION ssssrssssn*ssss*s**rss�rsrrsssrrrssssrssssssrssss*s*sssssssssssssssssss►sssaasssrsssssssrrrsrssrssserrrssrsrsrsssssssrssrsssrr* Address: kc12 WUh� Ridge, �cctt'pancy/Use: Il Parcel ID#: 12q, ��_ — 7j Zone: sa Owner:J ` ` ► Address: A-1r��O �Y TQ Qjl(I� P.E./R.A. or Contractor: PQYYII I On", Address: i Z ckh---e< <T,J, NQ(U14you . i ) Person in responsible charge: f-01VQUQ.WW Address: Q UAt r �L c laid � Ila Wb u Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE OF NEW YORK, COUNTY OF WESTCHESTER as: Qy I j a .I . . being duly swom,deposes and says that he/she resides at ,Z Ur,1 y �(Firrrinnt Name of Ap�pl cant) �,v (No.and Street) in T�U�C� �� W I M `U ,in the County of w Q����Ut S�{ in the State of that (City/Town/Village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:S `i for the construction or alteration of: f UCH' r4 fi cY 1 -4 Ywra.4 K-t Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structure/work has been erected/completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-10.A. of the Code of the Village of Rye Brook. `'�� Sworn to before me this L I Sworn to before me this 2q day of ,� '� , 20 2Z d of A.1 , 201L S' re of Prope wner Signature of Applicant P. ft(rL) jo- R4.t nt ame of rope Owner STATE �� `"tary plicant` STATE /!OF NEW YORJ�, /!OF NEW YORK�\ - I NOTARY PUBLIC t = t t - Nota Public = `<1�^ " �-w' .. = tOlPA6.H7fp?c Y/-k7/ Ie ,�1 QW,nd..we+�nea�Corry I / I �! - �-\ OIPA6347502 / C 77 lllllll �//1111111\\ QyE f3RC�k, l7 BUILDING DEPARTMENT „AUILDINGINSPECTOR /❑ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 , www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT -- - - - - - - - - - - - - - - - - - - ADDRESS: DATE: PERMIT# ISSUED: CT: �`�3LOCK: / LOT:_��� LOCATION: ` \ OCCUPANCY: V ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING f ❑ FOOTING DRAINAGE , ❑ FOUNDATION r ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION INAL OTHER a , R = ti ■ s N eMrg w v N N N v ar ■ cn ■ iii W> V 0 cca 4.4 0 ■ '� A � W � � � � U VJ : cn cn rr U _ W M _ p44 ~� s N x a� R O �T7 e--4 JE Le ■ a A M I �" O p a, O ■ Ln rY, PL( H u h�■M H lu W ^ c`1 O v v �O op A iS 0 -d a V PLO ■ (� ►� h /�� U Z 61 R, W I � ~ � cno � av ■ � z � O V A ,� z w CIS a� V M Q W a � � � v Od O J" W A � .o � � ■ Q w x a c oaf dW W W cD � a a PLO 74 0 ■ U U t. c Qy. ° vat g u W V 0-1 z � > � o x z w w :" umb H �I P-4 *4 W 17 x v -o 9 BUILDINGEPARTMENT VILLAGE OF RYE`" OK MAY 31 2022 DD 938 KING STREET RYE BR bk' NY 1057 VILLAGE OF RYE BROOK A "p BUILDING DEPARTMENT FOR OFFICE USE ONLY: Approval Date: UN 1 �� 2 mit# � �'� Application# Approval Signature: ARCHITECTURAL REVIEW BOARD: Disapproved: : Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: Application Fee: S Ab Permit Fees:-N 300"Y6 ROOF PERMIT APPLICATION Application dated: J UJ L� is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit to Re-Roof an Existing Building,as per detailed statement described below. Q 1. Job Address: kq;) CaAyw a0V 6nuc, S13L�. �a9' 3 Zone. Property Owner: �1((� �In Y� Address: hf heY Phone#: "l�� ��.� - 53�j�- Cell#: email: 2• Applicant: i wo VevynmAddress: 11 c e f1 +P Q Q7f AII,TV,1 Phone#: lu -) 1 — -1-tu Cell#: C 11 em-aiil: IJ �n 3. Roofing ontractor: V V y Address: VI `0 Phone#: �� - U Cell �����j —�Z�Z email: 1 11 (�y 4. Job Description,list all Methods&Materials: l 5 l (—M,- iM 6t r Y A VQ V4 4 � S 1 LP DA a 111tMlh 5 t 5. Estimated Cost of Job:$ k q A V) . U (NOTE:The estimated cost shall include all site improvements, labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 6. If corner property,indicate street frontage: 7. Construction Type: (LYA\Y\n NYS Construction Class: 8. Number of stories: Z Height: 9. Is garage being re-roofed:No: ( ) •Yes )Attached No: ( )•Yes: ( )Number of Cars: 10. Is roof peaked,hip,mansard,flat, etc: u IL 11. Estimated date of completion: 1 ik ob -I- 8112/2021 Please note that this application must include the notarized signature(s) of the legal owner(s) of the above-mentioned property, in the space provided below. Any application not bearing the legal property owner's notarized signature(s) shall be deemed null and void, and will be returned to the applicant. :tRY*Y k:FYc;FRxYk*x:k:F:kir:k kxx ::F ksc sc k****x:F F is:Fxik**********�:M�Fx ir*F;t'e**xa'r#;F;F<ak ki:k i*:F***k F*ir:FaF*ie ie*se k*ie eF***f:**ir it:is is k* STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and ftu-ther states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to be ore me this Z5l Swo to before me this day of , 202� da of 20 i atur o Property Owner ANNota iAp ' ant AA auof pe w antltc !i 1SEWypR1C�, STX t of Y t,IDE1c ► j�3Z 2(�t s �aF rtE�Y oRK�` t ypSP1t NO •��+ �SS10Nt IEl �4 -2- 8/12/2021 Perry Verrone, LLC 12 Center Street Pleasantville, NY 10570 info P12erryyerroneroofing.com Office: (914)747-7663 Fax: (914)747-7665 License WC 21701 H09 4/28/22 REVISED Prepared by Perry Josh Broitman 192 Country Ridge Drive Rye Brook NY 10573 914-523-5337 jbroit@optonline.net PROPOSAL ROOF REMOVAL AND REPLACEMENT • All existing asphalt roofing removed and carted from job site • 5/8"plywood installed on entire field of roof • GAF Weather Watch Ice and Snow barrier installed on all gutter edges,valleys and around skylights (6 feet up) • GAF TIGER PAW paper installed on the entire field of roof • GAF LIFETIME Timberline Architectural HDZ shingles installed on entire field of roof • GAF Cobra Ridge vent installed on all ridges of roof for attic ventilation • GAF TimberTex hip and ridge shingles installed on all ridges • Aluminum vent pipe boots installed over all vent pipes • Aluminum drip edge flashing installed around entire perimeter of roof • GAF Weather Blocker starters installed on all perimeter edges The price for the aforementioned work, which includes labor and material,totals to the sum of: $19,900.00 PRICE EXPIRES 90 DAYSAFTER ESTIMATE DATE Page 1 of 4 Initial&Date: 192 Country Ridge Dr, Rye Brook, NY 10573 (1) QuickMeasure April 27, 2022 Roof Reports in Under an Hour Prepared For: Perry's Roofing A N Contents Measurements Overview 1 Roof Area 2,499 sq ft Top View 2 Roof Facets 12 Side Views 3 Predominant Pitch 41 12 Lengths 4 Ridges/Hips 105 ft Pitches 5 Valleys 68 ft Areas 6 Rakes 185ft Summary 7 Eaves 118 ft Materials 8 Bends 0 ft QuickMeasure Top View Roof Reports in Under an Hour pet +� a y •. w s � A ti , tj,.k Iva Prepared For: Perry's Roofing © 192 Country Ridge Dr, Rye Brook, NY 10573 (1) QuickMeasure Side Views Roof Reports in Under an Hour 101 i •'ly Prepared For: Perry's Roofing © 192 Country Ridge Dr, Rye Brook, NY 10573 (1) QuickMeasure Lengths Roof Reports in Under an Hour AFlash Step Drip N 6 1 1 1 1 1 � 1 1 4 _ � 1 Eave Rake Ridge Valley 18 185 105 Lengths in feet Prepared For: Perry's Roofing 192 Country Ridge Dr, Rye Brook, NY 10573 (1) QuickMeasure Pitches Roof Reports in Under an Hour A N 4 1 4 4 4 4 a 4 4 4 Pitches in inches per foot Prepared For: Perry's Roofing © 192 Country Ridge Dr, Rye Brook, NY 10573 (1) QuickMeasure Areas Roof Reports in Under an Hour A N 64 84 108 334 606 106 84 100 ?9? 5b3 81 81 Areas in square feet Prepared For: Perry's Roofing 192 Country Ridge Dr, Rye Brook, NY 10573 (1) QuickMeasure Summary Roof Reports in Under an Hour Pitch 4 Area 2,499 Percent 100% Suggested Waste 0% 4% 7% 9% 11% 14% 19% Area 2,499 2,598 2,673 2,723 2,773 2,848 2,973 Squares 25 26 27 28 28 29 30 Roof Area 2,499 sq ft A Roof Facets 12 N Predominant Pitch 4 / 12 Bends Oft Eaves 118 ft Hips 0 ft Rakes 185ft Ridges 105 ft Valleys 68 ft Flash 4 ft Step 75 ft Drip Edge 303 ft Leak Barrier 450 ft Ridge Cap 105 ft Starter 303 ft Parapets 0 ft Notes:1)Measurements are rounded to the nearest whole number.2)Rakes are defined as sloped roof edges.3)Eaves are defined as level roof edges.4)Flashing pertains to level roof edges and excludes valleys.5)Step flashing pertains to sloped roof edges and excludes areas around penetrations.6)Drip edge=eaves+rakes.7)Waste table excludes additional materials needed for ridges,hips,valleys,etc.8)Suggested waste factor is based on the roof complexity and is provided for guidance purposes only. You should confirm the appropriate waste factor prior to ordering. Prepared For: Perry's Roofing 192 Country Ridge Dr, Rye Brook, NY 10573 (1) QuickMeasure Roofing Materials Roof Reports in Under an Hour Suggested Waste 0% 4% 9% 14% Timberline Products HDZ, HD, Natural Shadow, American bundle 77 80 84 87 Harvest, Reflector, Royal Sovereign, and Cool Series Low-Slope Roofing System Liberty Base/Ply Sheet roll 0 0 0 0 Liberty Cap Sheet roll 0 0 0 0 Starter WeatherBlocker bundle 4 4 4 4 Pro-Start bundle 3 3 3 3 Quick-Start roll 10 10 10 11 Roof Deck Protection Deck-Armor, Tiger Paw, FeltBuster 10 sq roll 3 3 3 3 Shingle-Mate roll 7 7 7 8 VersaShield roll 8 8 8 9 Leak Barrier StormGuard, WeatherWatch 2 sq roll 7 8 8 8 WeatherWatch 1.5 sq roll 10 10 10 11 Ridge Cap Seal-A-Ridge bundle 5 5 5 5 TimberTex bundle 6 6 6 6 Z-Ridge bundle 4 4 4 4 TimberCrest box 6 6 6 6 Attic Ventilation Cobra 4' Plastic Ridge Vents foot 34 Master Flow SSB960 Metal Slant-Black vent 10 Master Flow High-Capacity Dome Vent vent 5 Cobra IntakePro Rooftop Intake foot 67 Notes:1)These approximate quantities are based on estimated measurements and are for guidance purposes only. You should always confirm quantities prior to ordering and ensure you ore following local building code requirements. 2)For Timberline.3 bundles=0.984 squares. 3)Starter=eaves+rakes. 4)Leak barrier=bends+eaves+flashing+hips+rakes+step+ valleys. 5)Ridge cap=hips+ridges.6)Estimated quantity of attic ventilation products based solely on exterior roof area and intended for estimating purposes only. Installer must verity attic floor square footage,roof design,local code requirements,quantity/type/approved roof pitch of recommended vent products,and conditioned space under the roof. Always have a balanced attic ventilation system. In no case should the amount of exhaust ventilation exceed the amount of intake ventilation.For more info,visit gaf.com/ventcalculator.7)Low-slope products applied to 1/12 pitch areas.8)Timberline products applied to 2/12 pitch areas and above. Installed coverage will be less and depend on quantity and width of side and end laps. Prepared For: Perry's Roofing 192 Country Ridge Dr, Rye Brook, NY 10573 (1) F , High Definition'Shin• - LAYERLOCK� TECHNOLOGY 8 Y _ .f a r= America's • shinglegot • The same shingle you know and love, now . - •ck'" Technolog which powers - • widestnailing are• z • O Timberline® HDZ"' Shingles Benefits: Product details: • LayerLock'Technology—Proprietary durability, strength, and exceptional Product/System Specifics technology mechanically fuses the wind uplift performance. ■ Fiberglass asphalt construction common bond between overlapping ■ Dimensions(approx.):131/a'x 39'A' in StainGuard•Algae Protection— (337 x 1,000 mm) shingle layers. ■ Exposure:5%*(143 mm) Helps protect the beauty of your ■ Bundles/Square:3 ■ Up to 99.9%nailing accuracy— roof against unsightly blue-green • Pieces/Square:64 The StrikeZone"' nailing area is so algae discoloration.' ■ StainGuard' Algae Protection' ■ Hip/Ridge:TimberTexl;TimberCrest"; easy to hit that a roofer placed 999 ■ High Performance—Designed Seal-A-Ridges;Z'Ridge;Ridglass' out of 1,000 nails Correctly in our test. ■ Starter:Pro-Start;QuickStart'; with Advanced Protection'"'Shingle WeatherBlocker" ■ WindProven' Limited Wind Technology. Applicable Standards&Protocols: Warranty—When installed with in Seamless compatibility—The new • UL Listed to ANSI/UL 790 Class A the required combination of GAF ■ State of Florida approved Accessories,Timberline"HDZ' Timberline`HDZ"'Shingles are com- . Classified by UL in accordance with Shingles are eligible for an industry patible with traditional Timberline HDr ICC-ES AC438 g g y Shingles for the same look and feel Meets ASTM D7158,Class H first: a wind warranty with no homeowners and contractors ref ' Meets ASTM D3161,Class F maximum wind speed limitation.z 4 y ■ Meets ASTM D3018,SType 1 on for beauty and endurance. ■ Meets ASTM D3462 in Our legendary Dura Grip'sealant ■ ICC-ES Evaluation Reports ■ Perfect Finishing Touch—For the ESR-1475 and ESP-3267 pairs with the smooth microgronule ■ best look, use TimberTex'''Premium Meets Texas Department of Insurance surface of the StrikeZone' nailing Requirements Ridge Cap Shingles or TimberCrest"' ENERGY STAR`Certified(White Only) area for fast tack.Then,an asphalt to Premium SBS-Modified Ridge (U.S.Only);Rated by the CRRC;Can asphalt monolithic bond cures for Cap Shingles. be used to comply with Title 24 cool � Availability: roof requirements Bic Colors Availability: Results based on study conducted by Home Innovohon Research Labs. an independent research lob.comparing installation of Timberline HD' Shingles to Timberline"HDZ"Shingles on a 16-square roof deck using standard 4-noil noding pattern under controlled laboratory conditions OKI 4cfuol results may wry. lam. 15-year WindProven-limited wind warranty on Timberline"HDZ" "shingles requires the use of GAF starter strips,roof deck protection, edge cap shingles,and leak barrier or attic ventilation.See GAF Roofing _Blue _ System limited Warranty for complete coverage and restrictions.Visit Canyon k 6 it` J got comA_RS for qualifying GAF products. 'StainGuard"algae protection is available only on shingles sold in packages bearing the StainGua(cr logo Products with SlainGuand° algae protection ore covered by a 10-year limited warranty against blue green algae discoloration.See 34F Shingle&Accessory Limited Warranty for complete coverage and restnctans �— To be mixed on one root Timberline"HDZ`Shingles and Timberline HD" i MHunter Green Shingles must have matching 6-0igd codes found on the end of the burble. _ When mixed always use Timberline HD"installation instructions. Periodically tested by independent and internal lobs to ensure compliance with ASTM D3462 at time of manufacture 'Lifetime refers to the length of warranty coverage provided and means as long as the original individual owner(s)of o single-family detached _. residence for eligible second owner(s)I owns the property where the qualifying GAF products are installed.For other owners/structures,LifetimeMission Brown c, Patriot Red - - coverage is not applicable Lifetime coverage on shingles requires use of GAF Lifetime shingles only See GAF Shingle&Accessory limited Warranty o 'J for complete coverage and restrictions.Lifetime coverage on shingles and 1 accessories requires use of arry GAF Lifetime Shingle and any 3 qualifying GAF occessones.See GAF Roofing System Limited Nbrranry for complete coverage and restrictions Visit gal conVLRS for qualifying GAF products o Note'.It is difficult to reproduce the color clarity and actual cola blends Sunset Brick Weathered Wood of these products.Before selecting your color please ask to see severol tulla¢e shingles a AMERICAN F/ A O worm .l „�n"A"aR° We protect what matters most ..�AWAW Flll i!!1`I I I t I! 11 :1 �,I 1 ! j 1 i ''�1'i'''{ t LJ 1 � n ! t i l I +• !, 11�1• I 1 { d{li i' j. � ,jl l l i. . ; ! �{, t t{!N��i� �iA 11•!i�l!!!` ! •ji 11 #' „15 i I if l! ,JJf ! 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I+1 ,,+th'! ,! 1]i ! , !' � E,1 1 I!,. le r 1 !'••'•• ! l 1 li i i � �1 l�itll,,,!lt�J,1 e! ,l�f�tli �illti l ,lttlh�i! h. 1! Id ifl!! !rI. !!t ,'I I!'i,l 1'I 1 ,+!!'ii 1', !i,'•1,,Il!•1) , r! 1, 1 I 1 �11 I °, hI!�,lsN ! ! 1 �' )•! ill 1,1 i , ,, ,1 d.il.'!1,. 11 ee1f�' J I I!IJ•I ,, 1• i�r�.�!'�;!-ii��, !1:�:�1�!!.�1�11H1,°y& l t; �l:iilt!l��!�! "'! !i ���]t!�filji!! �,I.I!i!i i!•I li1!1]I! !!111: l!1�11!1!hl tl !• OO2 n. t c y CM v N a� L Y � L y O CS. C) X LO aLi CC 4�.+ C) / t )R y O 0 � I I it O p'y CA� � t .►) �] —J (D W 0 c p pC� J Z W 001110,o111tection Iry Z L Z L .'� ./..J O U) J y ^ W J O W ` ' Q } W W Z 3 uW ko p ` V W- U y x •rG �v \ Ilf W cv Q �: .N C) a 5 r Q w a w o r••i 0-0 d a > w C t: es 8 L a y i U d 7 U C d a� N UL Y V E- . 7 cas»� A AQ ��' DATE(MMIDDIYYYY) AcoRE CERTIFICATE OF LIABILITY INSURANCE �, 85/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy. certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Erich Courant& Company PHONE FAX 25 East Spring Valley Ave Suite 270 (A/C.No,Mom 201-226-1200 111 No:201-226-1201 Maywood NJ 07607 ADDRESS: INSURERS AFFORDING COVERAGE NAIL 0 License*BR525310 INSURER A:Evanston Insurance Co 35378 INSURED PERRVER-01 INSURER B: Perry Verrone LLC 12 Center St INSURERC: Pleasantville NY 10570 INSURER0: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1679233067 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL'.SUBR pOLICV NUMBER MOLDY EFF M LICY EXP LIMITS LTRNsn vim A X COMMERCIAL GENERAL LIABILITY 3AA409339 711/2021 7/1/2022 EACH OCCURRENCE s4,000,000 DAMAGE TO H CLAIMS-MADE �OCCUR PREMISES EaENTED occurrence $1W'000 MED EXP(Any one $5,000 PERSONAL 6 ADV INJURY s 4,000,000 PGEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 PRa POLICY I JECT C LOC PRODUCTS-COMPIOP AGG $4 000,000 r� �_ OTHER' $ AUTOMOBILE LIABILITY ' COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) _ OWNED SCHEDULED BODILY INJURY(Per accident) _ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per aCddant $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DIED RETENTION - S WORKERS COMPENSATION rr AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETORIPARTNERIEXECUTIVE ❑ E.L.EACH ACCIDENT f OFFICERWEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE _ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Village of Rye Brook 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 UJ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Workers' YORK CERTIFICATE OF E Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured 914-867-1747 Perry Verrone LLC DBA Perry's Roofing 1 c.NYS Unemployment Insurance Employer Registration Number of 12 Center Street Pleasantville,NY 10570 Insured Work Location of Insured(Only required if coverage is specifically limited to 1 d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State. i.e.,a Wrap-Up Policy) Number 26-2754386 2. Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Continental Indemnity Village of Rye Brook 3b.Policy Number of Entity Listed in Box"la" 938 King Street 46-884191-16 Rye Brook, NY 10573 3c.Policy effective period 03/01/2022 to 03/01/2023 3d.The Proprietor,Partners or Executive Officers are ❑ included.(Only check box if all partners/officers included) X all excluded or certain partnersiofficers excluded. This certifies that the insurance carrier indicated above in box"3" insures the business referenced above in box"1 a"for workers' compensation under the New York State Workers'Compensation Law. (To use this form, New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.)Otherwise.this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Steven Diamond(President) (Print name of authorized representative or licensed aqent of insurance Garner) Approved by: 02/28/2022 (Signature) (Date) Title: Licensed Insurance Broker Telephone Number of authorized representative or licensed agent of insurance carrier 516-488-3040 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-17) www.wcb.ny.gov